Paging Dr. Suchard

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wintergreen48
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Paging Dr. Suchard

#1 Post by wintergreen48 » Wed Nov 21, 2007 10:26 am

A medical/toxicological question for you, if I may be so bold...

When I was dealing with my migraine last week, I consumed a large number of painkillers, all of which have 'stuff' in them that you are not supposed to take in large quantities because of possible adverse effects; they all discourage people who drink large amounts of alcohol from using them at all, again because of possible adverse effects. I know that the reason for this is that the 'stuff' in them is metabolized in the liver, and if you take too much, it will make your liver explode and you will die (or something), and alcohol (which is also metabolized in the liver) makes it worse. So I did not consume any alcohol while I was overdosing on the drugs.

Here's the thing... I actually was a biology major, and while I know some of this stuff, my focus was in a different area (you want to know anything about dorsal nerve roots, or the relationship of the transfer of sodium ions to synaptic transmissions, give me a call; you want to know something about body parts that aren't part of the neurosystem, call someone else). You, on the other hand, are the living god of toxicology and the impact of poisons on body parts. So my question (if I may be so bold as to ask a question): is the problem with all these drugs (especially when combined with alcohol) based upon cumulative effects (that is, you blow out part of your liver each time you use the drugs, until eventually not even Hannibal Lechter would be interested in you), or, is it something that happens all at once, when you go over some threshold?

Inquiring minds want to know...

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FreddyTheElfWithNoRetinas
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#2 Post by FreddyTheElfWithNoRetinas » Wed Nov 21, 2007 10:37 am

I told Jeff to check out your message.

I couldn't read it myself.
Alas, poor Yorick! I knew him, Horatio

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jsuchard
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#3 Post by jsuchard » Wed Nov 21, 2007 10:50 am

Wintergreen,

There is more information I need to know to answer your questions:
1) What was/were the medication/s you took?
2) How much did you take, and over what time period?
3) Any new physical symptoms now?
4) Describe your alcohol drinking habits: how much, how often?
5) Are you known to have any pre-existing liver problems?

My presumption is that you took something with acetaminophen (Tylenol) in it, or you wouldn't be as concerned specifically about your liver. Acetaminophen is a remarkably safe and effective drug. But since it is so commonly available, and many people mistake safety for "I can take as much as I want without consequence", it turns out to be responsible for a great number of cases of acute liver failure.

Even so, it takes a great deal of acetaminophen to ruin your liver. As a general rule, it takes 150 mg/kg consumed all at once (about 10 grams) before you even start getting to the range where you might need to be admitted to the hospital for treatment. And even at that threshhold, virtually everyone recovers just fine, and probably would even if they weren't admitted and treated.

It is not as well known how much acetaminophen you have to ingest over a longer period (several days or more) to injure your liver. There are even published cases where people have slowly increased their daily acetaminophen intake over prolonged periods (due to opiate drug addiction, where they are taking pills like Vicodin or Percocet which contain acetaminophen) and have tolerated massive doses for months without liver problems; nevertheless, such doses consumed by a novice might very well kill them.

As far as ethanol consumption increasing your chances of liver injury, that is, in my opinion, a myth. The medical literature suggesting that chronic ethanol use predisposes one to acetaminophen liver injury is pretty crappy, and mostly based on poorly documented case reports. Systemic studies looking specifically at this issue have repeatedly failed to demonstrate any increased risk when acetaminophen is ingested at no more than the maximum recommended daily dose (4 g/day). There are also studies showing that 6 or 8 grams/day cause no demonstrable injury. The theory makes sense, but the evidence just isn't convincing at all. In fact, acute ethanol intoxication has been shown to be protective against acetaminophen hepatotoxicity!
* Either Arglebargle IV or someone else.

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jsuchard
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#4 Post by jsuchard » Wed Nov 21, 2007 10:54 am

Also:

Even if someone damages their liver from acetaminophen, when they recover, they recover completely. The liver returns to normal, and they do not have increased susceptibility to such injury in the future.

...either that, or they die of fulminant liver failure. There are only two options: live with a normally functioning liver, or die with a liver that turns to mush. [There is a third option of liver transplant, of course.]

So, if you haven't succumbed to fulminant liver failure within several days of your acetaminophen overdose, then you will be just fine.
* Either Arglebargle IV or someone else.

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jsuchard
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#5 Post by jsuchard » Wed Nov 21, 2007 10:58 am

Now, to specifically answer your question about whether the liver injury is a cumulative thing or a threshhold thing:

In general, at least with regard to acetaminophen overdose, it is a threshhold thing. You need to go above a certain threshhold with an acute overdose, and probably also with a sub-chronic overdose. However, chronic use at reasonable doses is safe, even for those with underlying liver disease and/or ethanol use.
* Either Arglebargle IV or someone else.

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wintergreen48
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#6 Post by wintergreen48 » Wed Nov 21, 2007 2:43 pm

jsuchard wrote:Wintergreen,

There is more information I need to know to answer your questions:
1) What was/were the medication/s you took?
2) How much did you take, and over what time period?
3) Any new physical symptoms now?
4) Describe your alcohol drinking habits: how much, how often?
5) Are you known to have any pre-existing liver problems?
1. Alleve, Excedrin for Migraines, something in my co-worker's purse.

2. 1 'full dose' of Alleve early in the morning, 1 'full dose' of the Excedrin thingie in the early afternoon, 1 of something in my co-worker's purse in the evening.

3. Nope, and by the end of the day I was feeling pretty good; I usually feel completely exhausted when the migraine goes away, but this time I felt 'alert' (probably due to the gallon of tea I drank during dinner).

4. A sip of wine at Communion on Sunday, a glass (sometimes two) of wine with dinner maybe once every two-three months. Not drinking during the dinner at Blackstone's was not a big deal, because I usually don't drink anyway.

5. Nope, and at my recent physical the blood work and studies (routine, not because of any problems) were quite good on all fronts, specifically including liver stuff (and my cholesterol level is really low-- even if I didn't have any 'good' cholesterol at all, my total cholesterol levels are low enough that I could mainline eggnog without fear of adverse consequences).

My question was not so much about any problems that I was having, but whether occasionally using a lot of stuff like acetaminophen will, over time, kill me. Based upon your answers, it looks like I will have to find some other way to ruin my health. Which is good news. Thenk yew.

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#7 Post by kayrharris » Wed Nov 21, 2007 2:49 pm

Excedrin Migraine is full of caffeine, so that's probably what made you nice and alert at the end of the day. (65mg to be exact)

http://www.migraines.org/treatment/pro_exmg.htm

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